| NPI | 1558577239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.007292) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34001394A) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-11-04 |